Extension and Exemption Requests

About this Page

This webpage provides information on the Centers for Medicare & Medicaid Services (CMS)’s Hospice Quality Reporting Program (HQRP) Exemption and Extension Policy for Extraordinary Circumstances. This policy applies to both the Hospice Item Set (HIS) and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

This webpage provides information on two aspects of this general Exemption and Extension for Extraordinary Circumstances policy:

• Provider-initiated requests for exemption or extension for extraordinary circumstances.
• CMS-initiated waivers for exemption or extension for extraordinary circumstances that are based on FEMA-designated disasters or federally initiated public health emergencies.

For additional assistance, hospices may submit questions related to the extensions or exemption requirements to the following email address: HospiceQRPReconsiderations@cms.hhs.gov.

Background

Although hospice providers are required to submit HIS and CAHPS® data to CMS to comply with HQRP requirements, CMS recognizes that there are instances where an extraordinary circumstance beyond the hospice’s control (e.g., natural disasters) may delay or prevent submission of required data.

CMS does not want the extraordinary circumstance to unduly increase provider burden, nor does CMS want to negatively impact a hospice provider’s annual payment update (APU) and compliance with HQRP requirements during this time. In the FY 2018 Hospice Final Rule, CMS finalized the Exemption and Extension for Extraordinary Circumstances policy, (82 FR 36671).

 This policy consists of two parts:

• Provider-initiated requests for exemption or extension for extraordinary circumstances: If a hospice provider experiences an extraordinary circumstance, they can initiate a request for extension or exemption. Note: The request must be initiated within 90 days of the extraordinary circumstance event, and it must be sent to CMS via email following the instructions below.
• CMS-initiated waivers for exemption or extension for extraordinary circumstances: When a disaster, including pandemics, affects a large geographic area or a large number of hospice providers, CMS can automatically grant an exemption or extension to groups of affected providers. In CMS-initiated waivers, providers do not need to take any action to be granted an exemption or extension. CMS-initiated waivers are communicated to providers via the communication channels noted below.

When an extension or exemption is granted (either through the provider-initiated request or the CMS-initiated waiver), a hospice will not incur payment reduction penalties for failure to comply with the requirements of the HQRP, for the time period for which the extension or exemption was granted.

Note: The Exemption and Extension for Extraordinary Circumstances is different from the CAHPS® size and newness exemptions; for more information on CAHPS size and newness exemptions, please see the Hospice CAHPS® webpage.

Definitions

Extraordinary Circumstance:

Disasters, including pandemics, prevent the timely submission of quality data. A disaster may be widespread, affect multiple structures, or be isolated and affect a single site only.

Extension:

If an extension is granted, the data submission deadline is extended. There have been situations where CMS has allowed an extension to the deadline for data submission. If granted an extension, the hospice is still responsible for submitting data collected during the time period in question. The extension allows the provider to submit the data “late” (e.g., 30-45 days past the deadline) for a specified time period, without any negative impact on HQRP compliance requirements for APU.

Exemption:

Data submission for HIS and/or CAHPS® is waived for a specified time period. With an exemption, the hospice is exempted from data submission entirely for a specified time period, without any impact on HQRP compliance/APU.

Requesting a Provider-Initiated Exemption or Extension Request

The HQRP does not have a specific extension or exemption request form. Instead, hospice providers are required to submit an email request within 90 calendar days of the date the extraordinary circumstance occurred.

How to Submit a Provider-Initiated Exemption or Extension Request

Extension or exemption requests and supporting documentation must be submitted via email with the subject line that contains the text: “ACA 3004 Extension and Exemption Request” and the Hospice CCN (e.g., ACA 3004 Extension and Exemption Request, CCN = XXXXXX) to the following email address: HospiceQRPReconsiderations@cms.hhs.gov.

The request must include the following information:

• The Hospice CMS Certification Number (CCN),
• The Hospice business name,
• The Hospice business address,
• The Administrator contact or designee representative information, including name, email address, telephone number, and physical mailing address,
• The reason(s) for requesting an extension or exemption,
• The time period the hospice wishes to request an extension or exemption, and
• Which reporting requirement the extension/exemption is being requested for (i.e., HIS, CAHPS®, or both).

The request for an extension or exemption must be accompanied by supporting documentation demonstrating the need. CMS will be unable to review any request that fails to provide the necessary documentation along with the request. Supporting documentation must include the following:

• Proof of extraordinary circumstances beyond the hospice's control, (for example disasters), may be in the form of a news article, pictures, or other documentation attesting to the incident,
• Dates of occurrence; and
• Other documentation that may support the rationale for seeking an extension or exemption.

The key is that the provider must show how the extraordinary circumstances beyond the hospice’s control impact the hospice’s ability to submit quality data timely.

CMS Response

• CMS will provide written acknowledgment upon receipt of the request to the Administrator or Administrator designee contact provided in the request.
• CMS will determine whether the evidence submitted supports the extension or exemption request. The decision will be made based solely on the documentation provided.
• CMS will provide written notification of the decision to the Administrator or Administrator designee indicated in the request. The response usually occurs within 30 days of receipt of the request.

If clear evidence to support the need for an extension or exemption exists, CMS will provide the extension or exemption for a determined period of time. If no clear evidence to support the need is given, the request will be denied.

Please ensure that no protected health information (PHI) or personally identifiable information (PII) is included in the documentation being submitted for review.

Communicating CMS-initiated Waivers

If CMS grants a waiver, CMS will communicate the decision through routine channels to hospices and vendors, including, but not limited to, Open Door Forums, ENews and notices on the CMS Hospice Quality Reporting Spotlight & Announcements webpage.

For disasters like hurricanes or pandemics, CMS will post updates on the CMS Emergencies webpage. We recommend you check the CMS Emergencies web page frequently for updates.

Special Circumstances for Hospice Providers

CMS waivers are often made at the agency-level, for a variety of care settings at once; thus, CMS-initiated waiver language communicated through the channels above may not be specific to hospice agencies.

CMS realizes that hospice care delivery is unique compared to other care settings. For example, a hospice may have a business office located in one state but provide services in another state. In these instances, for the HQRP, it is CMS’s intent for waivers to apply to the hospice’s service area, not their business address, corporate office, etc. If CMS grants a waiver for an affected area in which your hospice agency serves patients, you can assume the waiver applies to your agency. If your agency is later found non-compliant due to late or missing data for the time period of the disaster, CMS would encourage your agency to apply for Reconsideration.

Hospice QRP: Disaster Protocol

Hospice providers affected by disasters in counties that are identified through the Federal Emergency Management Agency (FEMA) as “Designated Areas” will be provided guidance and further information via this webpage concerning data submission requirements as it becomes available.

In addition, details and materials are also available on the CMS Emergencies webpage.

 Note: designated areas may be updated to add affected areas by disasters. Please continue to check back frequently for updates.

Updates

Reporting Exception Granted Due to Hawaii Kona Low Weather Systems and Commonwealth of the Northern Mariana Islands Super Typhoon Sinlaku

The Centers for Medicare & Medicaid Services (CMS) is granting extraordinary circumstance exceptions¹ under certain Medicare quality reporting and value-based purchasing programs to providers and facilities located in areas affected in the state of Hawaii by the Hawaii Kona Low Weather Systems, and in the Commonwealth of the Northern Mariana Islands by Super Typhoon Sinlaku, as identified by both Department of Health and Human Services (HHS) Public Health Emergency (PHE) declarations (PHE | Hawaii - Severe Storms; PHE | Northern Mariana Islands – Super Typhoon Sinlaku) and the Federal Emergency Management Agency (FEMA) major disaster declarations (FEMA | HI Major Disaster Declaration (4909); FEMA | Northern Mariana  Islands Major Disaster Declaration (4910)), to support these providers and facilities which may require the focusing or redirecting of resources toward accommodating circumstantial care needs of their patients and addressing potential infrastructure challenges affecting their healthcare operations.

Affected areas covered by these exceptions are detailed on the Designated Areas: Disaster 4909 and Designated Areas: Disaster 4910 pages, under the section Public Assistance, designations PA-A and PA-B, of the FEMA website. If FEMA expands the major disaster declaration to include additional affected areas at a later date and it is operationally feasible, CMS will likewise extend reporting requirement exceptions to accommodate these areas but will not necessarily publish updated communications.

At the time of this communication, the exceptions being granted are for the reporting requirements and deadlines as detailed in the table below:

1 The terminology “exception” is used as a general term intended for ease of reference to collectively refer to extraordinary circumstance exception (ECE) policies established under separate programs and may not be consistent with the specific terminology established under each individual program.

Additional Reporting Requirement Exceptions

Providers and facilities located within a designated area listed in the FEMA disaster declaration who seek an exception for a reporting requirement not covered by this table may request an individual exception using the applicable ECE request process for the respective program(s). CMS will assess and decide upon each ECE request on a case-by-case basis.

Merit-based Incentive Payment System (MIPS)

In addition to the above table, the MIPS Automatic Extreme and Uncontrollable Circumstances (EUC) policy will be applied at the individual level to MIPS eligible clinicians identified as located in the aforementioned affected areas. Additional information on this policy can be found in the 2026 MIPS Automatic EUC Factsheet.

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